The Paradigm Shift in Medicine and How it Affects Technology
By Shafiq Rab, M.D., MPH, VP-CIO, IT, Hackensack University Medical Center
Currently, we are seeing a paradigm shift in medicine that is revolutionizing the way medical care is provided. This shift is a change in the control of healthcare. It’s moving from hospitals and physicians into the hands of the patients. The delivery of healthcare is moving from large buildings and big offices into patients’ homes and mobile devices. The driving force behind this shift begins with the economics behind the 90 million current participants in the health insurance exchanges where consumers are beginning to fully realize the actual cost of healthcare. This sticker shock results in a consumer driven model of healthcare where quality is a given, transparency is a must and access is a key differentiator for providers. The new model means that we as healthcare providers must step up our game and the one clear investment that will differentiate competitors in providing the convenience, access, quality and transparency required to acquire and retain patients.
Both the result of these requirements -as well as their cause -is the advancement of healthcare information technology into state-of-the-art apps and medical grade sensors all made possible by the world’s advancement in mobility.
“The delivery of healthcare is moving from large buildings and big offices into patients’ homes and mobile devices”
The market is moving to value-based reimbursement combined with rapid changes in insurance markets, which has created a voracious appetite for information to be delivered when and where the patient needs it.
Technology at Hackensack University Medical Center (HackensackUMC)is adapting to the new ways of delivering this information. We have been successful in putting our Electronic Health Record (EHR) on a cloud infrastructure and delivering analytics via apps. At the same time, we have implemented a universal access strategy facilitating a “bring your own device” (BYOD) model for mobility to deliver information to the hands of healthcare providers.
We have been very effective in giving the power of information to patients through our MyChart portal. For our Accountable Care Organization (ACO), we have empowered our care coordinators with tablets and other mobile technology.
We facilitate the free flow of information between hospital, providers, patients, ACO and pharmacy enabling interoperability through the Epic Care Everywhere Continuity of Care Document (CCD) exchange, the direct protocol, our New Jersey Health Information Exchange (HIE) as well as direct interfaces where necessary.
We found out that the transformation to the new healthcare paradigm has not only saved hospital operations costs, but also we are able to decrease overall IT spending via the consolidation of licensing, and the reduction in space, hardware refresh costs and turnaround times.
Some other examples of how HackensackUMC is adapting our technology to this shift:
• Moving the entire data center to our private cloud
• Virtualizing the desktop experience to provide consistent single-method access to an always up-todate clinical desktop with badge-based authentication and single-sign-on
• Providing iPads for our patient transporters to bring notification and interaction to the bedside, enabling significant increases in patient satisfaction
• Providing iPhones for nurse mobile medication delivery
• Offering NICU Video Visitation to connect mothers to their babies and the entire family via secure mobile video
• Giving patients direct access to their care by using theMyChart application providing appointments, results and bill pay via website and mobile app
• Accessing mobile apps for business intelligencefor real-time insight to leadership from their hand-held devices
• Providing a social media network and mobile apps for a study on the management of pediatric diabetes patients
By moving our services to the cloud, we have created an environment of business continuity. By using mobile and apps, we enhance the usability and access to health information over smart devices and bring care to the bedside in the hospital and into the patient’s home. By leveraging mobility, we have enhanced the communication between the healthcare provider, the patient and their family in managing and controlling chronic diseases.
We are using analytical data from the highest level of the organization to the most granular level possible for overall performance improvement. HackensackUMC has innumerable uses for the electronic data and resources available to reinforce and accomplish our value-based, Institute for Healthcare Improvement (IHI) triple aim goals for improving the patient experience, improving healthcare and reducing costs. For example:
• An assessment tool developed in Epic has enabled early nurse-driven consults by the palliative team. This approach has facilitated early appropriate treatment of patients in need of palliative care and has directly contributed to diseasespecific certification from The Joint Commission.
• A new workflow in Epic was specifically designed to give real-time clinical alerts to the care team for febrile neutropenic oncology patients who have arrived in the Emergency and Trauma Center. This tool allows for immediate, appropriate selection of approved antibiotics for neutropenic patients. This early intervention was designed to improve clinical outcomes in this vulnerable patient population.
• An Epic/ICU monitoring tool is designed to measure severity of patient condition in the ICU. It allows us to prioritize care delivery and resource utilization. Because this is real-time data, clinicians can make decisions based on dynamic apache score/acuity score.
• In a recent 30-day readmission CHF project patients were sent home with tablets for assessing symptoms. The tablet program is proving to help reduce readmissions in patients with congestive heart failure, chronic obstructive pulmonary disease and diabetes - our ACO's three leading causes of readmissions.
• Through our analytics capabilities, we provide live reports on a daily basis of EMR data that is pushed to our quality initiative committees, who can then take action on this real time data, prior to the patient’s discharge to sustain our performance improvement program.
• Based upon analytics, we found compliance to be higher when our patients are sent home with a 30-day supply of their prescription drug medications in their hands. We have made this a standard operating procedure in our transitions of care initiative.
Of course, with all the benefits of mobility and cloud comes extreme responsibility of security, which is the Achilles heel of today’s healthcare IT departments. At HackensackUMC, among the varied defensive measures we’ve taken, we have instituted several proactive safeguards such as performing semi-annual security audits and ongoing penetration tests, as well securing everything by consolidating computing to the datacenter and encrypting all our data at motion and at rest.